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Procedures of Limited Clinical Value - a joint statement from RCS and BOA

05 April 2011

The British Orthopaedic Association and the Royal College of Surgeons have become increasingly aware that many previously available elective surgical procedures are being stopped across the NHS. Trusts have been drawing up lists of ‘procedures to stop commissioning’ without clinical advice and without publicity or consultation with their local communities.

‘Procedures of Limited Clinical Value’ (PLCV) is the term NHS managers have applied to these procedures they no longer wish to fund as a way to justify the practice.

It is not a new term and procedures previously defined in this way have included complimentary or alternative treatments, aesthetic treatments, or treatments without NICE guidance of cost-effectiveness. However, with financial restrictions to public spending tightening, the phrase has been extended to many proven operations known to enhance health and improve quality of life have been included in this category, and hence are being denied to patients who need them. Many of the procedures deemed of low value prevent complications and more serious conditions developing later.

The RCS and BOA believe that denying patients access to these operations ultimately endangers the lives of patients and the standard of treatment available in the NHS. It is also of concern that decisions which have such a great impact on the quality of lives for patients is being undertaken without proper, honest public debate and consultation.

Surgeons believe that:

  • Procedures which alleviate pain, improve mobility and quality of life, but the benefits of which are not seen immediately, should remain core NHS activity.
  • Decisions to recommend surgery should be taken by clinicians who have seen, assessed, counselled and consulted the patient.
  • There is a risk of building up a backlog of unmet need that will have to be dealt with at some time in the future, and a legacy of serious long term health problems.